Did your antenatal class teach you all the pros and cons of an induction of labour? This is not a decision to take lightly.

Here is a copy of my article that appears at www.birthgoddess.com.au

http://www.birthgoddess.com.au/2013/01/so-you-are-thinking-about-an-induction/

So you are thinking about an induction.

When an induction is used for clear medical reasons, it can be life saving and then there is no argument that an induction is necessary. However, if you are thinking about agreeing to an induction for social reasons, convenience or without clear medical evidence, you need to read this first.

Some doctors will say being 10-days overdue is a good reason for an induction, but it really important to understand that you estimated due dates is just that… an estimation. Only 3% to 5% of babies are born on their estimated due date (sometimes called guessimated date) and full term is actually up to 42 weeks of pregnancy. The reliance on ultrasound for dating is also flawed, as there is an error margin of plus or minus 7 to 10 day. Your individual length of menstrual cycle and family history should always be taken in to consideration when calculating your due date. So for your baby to be born safely when he or she should be, you need supporting evidence that things are not safe to continue with your pregnancy before agreeing to an induction.

Your caregiver can check for signs that your baby is fine to stay put for a while longer. Ultrasounds can be done to check that the placenta is still functioning as it should be and that the amniotic fluid level is fine. You can also agree to more frequent monitoring, involving you going to the hospital to have the baby’s heart rate monitored for a short period of time.

But you are tired of being pregnant and fed up with being so uncomfortable. Or perhaps your obstetrician won’t be available at the time of your due date. Or you are worried that you won’t be ready or need to organise other children. And it can be so disappointing and frustrating when your baby doesn’t arrive on their due date, but remember that waiting for your baby to come when he or she is ready reduces the risk of accidental immaturity and increases the chances of a straight forward labour and birth.

Inductions are not without risks. The main risk of an induction of labour is the risk of “the cascade of interventions”. This is where one intervention interrupts the normal progress of labour leading to more and more intervention. The synthetic hormone used during an induction can make your labour quicker and stronger than your body would naturally do it. This means that the body’s natural pain relief, endorphins, find it hard to keep up with the pace. This can leads to the use of drugs and epidurals. Epidurals are associated with an increase risk of instrumental delivery and c-sections. This in turn leads to the risk of maternal dissatisfaction, post-natal depression and health problems for the baby.

There is also a risk that the synthetic hormone can cause your contractions to be too strong and over stimulate your uterus. Because of this, most care givers will want to continually monitor the baby’s heart and your contractions. This, along with the drip, can immobilised you on the bed making it difficult to get in to a comfortable position and interfering with the important role gravity plays in labour and birth.

The contractions can also be too strong for your baby. In a normal labour the contractions will naturally come and go in 2 to 5 minutely cycles. This is nature’s way of giving you and your baby enough time to recover before the next contraction begins. When the labour is induced, the medications can sometimes force the uterus to contract too much, not allowing your baby ‘recovery time’. This can cause foetal distress due to a lack of oxygen and mean that further intervention is needed. Once again triggering the “cascade of interventions”.

Over-riding the body’s natural production of oxytocins also causes decreased sensitivity to the naturally released oxytocins when the baby is suckling at the breast. Your baby could also have difficulty breathing and a weak suck because of the drugs used, especially pethidine, or because they have been born too early. This can lead to difficulty establishing breast feeding in the first few days after the baby is born.

So if you are considering an induction because to are overdue and you just can’t wait to see your baby, it might be worth trying some natural, fun ways of stimulating labour first.

Oxytocin is called the love hormone because it is released during orgasm and nipple stimulation. Plus semen contains prostaglandins which can help ripen the cervix. So sex is a much more natural way of stimulating labour than a pessary and a drip. (However you should avoid penetration if the membranes are broken but you can still use nipple stimulation.)

Warm baths and massage can reduce anxiety and adrenalin levels. Adrenaline can block the flow of oxytocins so by reducing high stress levels you may allow your body to go in to labour.

Castor oil (2 tablespoons in a glass of orange juice) or eating curry might work. It is suggested that they may start labour because they stimulate the gut and bowel which encourages the uterus to start contracting. Spicy foods can cause heartburn and, if you are not used to them, irritate the bowel, so you might want to try a milder curry first. There is no scientific evidence for this way of naturally inducing labour though many women swear by it.

Acupuncture is also thought to stimulate the onset of labour and is used in many eastern cultures. Acupuncture involves the insertion of very fine needles into specific points of the body. According to traditional Chinese philosophy, this stimulates the energy within the body to act on a specific organ function or system. Studies into this are limited but none have shown any ill-effects from the use of acupuncture for mother and baby. Acupuncture is generally considered safe at this stage of pregnancy.

Walking is another safe method to try. It is thought that the pressure of your baby’s head pressing down on the cervix from the inside stimulates the release of oxytocins, hopefully bringing on labour. Also, just being upright gets the forces of gravity working for you, encouraging the baby to move down onto the cervix.

Although an induction can introduce real risks to what could be a perfectly normal birth and greatly increases the likelihood of further interventions; from pain relief to emergency Caesarean sections, sometimes they are absolutely necessary.

As with all interventions offered, I recommend you question your doctor’s advice by using your BRAIN.

This means, you ask…
What are the Benefits of what you are suggesting?
What are the Risks of what you are suggesting?
What are the Alternatives to what you are suggesting?
(Ask yourself) What are my Instincts telling me?
What happens if we do Nothing?

Finally, remember that if you truly need an induction of labour for clear medical reasons, then you are doing what is best for your baby. And being aware of the risks means you can do all that you can to minimize them.

 

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